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1992, 08-10 Permit App: 92006235 Mechanical FixturesU, � JOB STREET ADDRESS: CITY/STATE/ZIP: OWNER: MECHANICAL PERMIT APPLICATION FORM Information -Worksheet MAILING (Street) PARCEL NUMBER: q2 PHONE NUMBER: (City/ tate) (Zip) CONTRACTOR:-;A4,-Ayn -s +Arm 4Q , LICENSE NUMBER: _ _-� M-var- I t b B L PHONE NUMBER: --M o O MAILING ADDRESS:__- 1�;-\lt3 lC. rrwzS'F -elA Lk (Street) ( y/State) .(Zip) MECHANICAL WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS I UNIT = AMOUNT DUCTWORK SYSTEM WOODSTOVE/INSERT _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ GAS WATER HEATER HEATING EQUIPMENT <100,000 BTU _ _ _ _ - HEATING EQUIPMENT +100,000 BTU _ _ _ _ _ GAS PIPING (1 - 4 OUTLETS) _ _ _ _ _ _ _ GAS PIRING (5 OR MORE. EACH:)_ _ _ _ REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP) REFRIG 101-500M BTU _ _ _ _ _ REFRIG 501-1,000M BTU _ _ _ _ _ _ _ _ _ REFRIG 1,001-1,750M BTU- - - - - - _ _ REFRIG +1,750M BTU _ _ _ _ _ _ HEAT PUMP & AIR CONDITIONER 0-3 TONS HEAT PUMP & AIR CONDITIONER 3-15 TONS _ HEAT PUMP & AIR CONDITIONER 15-30 TONS _ HEAT PUMP & AIR CONDITIONER 30-50 TONS HEAT PUMP & AIR CONDITIONER +50 TONS _ VENTILATING FANS EVAPORATIVE COOLERS __ _- - - - -_ -_ UF -0065) - -_HO -_ _- TYPE I HOOD (PER 12' OR°12' PTN. OF OD) TYPE II HOOD______________ CLOTHES DRYER RANGE- - - - - - - - - - - - - - GAS LOG - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _ UNLISTED GAS APPLIANCE <400,000 BTU _ _ UNLISTED GAS APPLIANCE >400,000 BTU _ _ USED APPLIANCE <400,000 BTU_ _ _ _ _ _ _ USED APPLIANCE >400,000 BTU_ _ _ _ _ _ _ AIR HANDLER <10,000 CFM _ _ _ _ _ _ _ _ AIR HANDLER >10,000 CFM NOTE: MINIXUX PERMIT FEE IS $35.00 SIGNATURE X$10.00 - x 25.00 = x 10.00 = AOI x 12.00 = x 15.00 = x 4.00 = x 1.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = x 12.00 = x 20.00 = x 25.00 = x 35.00 = x 60.00 = AA 10.00 = x 10.00 = x+50.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 10.00 = x 50.00 = x100.00 = x 50.00 = x100.00 = x 12.00 = x 15.00 = SUBTOTAL $ Q PLUS: PROCESSING FEE + $ 25.00 EQUALS: TOTAL PERMIT FEE DUE = $ 610 ,%i ♦ ASpokane County Department of Building and Safetx 1217 D.wwd...w.. A..ww..w n.+wbw..w soon nnNen /C n% Are •fere